npj Digital Medicine (Mar 2024)

Effect of clinical decision support for severe hypercholesterolemia on low-density lipoprotein cholesterol levels

  • Hana Bangash,
  • Seyedmohammad Saadatagah,
  • Mohammadreza Naderian,
  • Marwan E. Hamed,
  • Lubna Alhalabi,
  • Alborz Sherafati,
  • Joseph Sutton,
  • Omar Elsekaily,
  • Ali Mir,
  • Justin H. Gundelach,
  • Daniel Gibbons,
  • Paul Johnsen,
  • Christina M. Wood-Wentz,
  • Carin Y. Smith,
  • Pedro J. Caraballo,
  • Kent R. Bailey,
  • Iftikhar J. Kullo

DOI
https://doi.org/10.1038/s41746-024-01069-w
Journal volume & issue
Vol. 7, no. 1
pp. 1 – 9

Abstract

Read online

Abstract Severe hypercholesterolemia/possible familial hypercholesterolemia (FH) is relatively common but underdiagnosed and undertreated. We investigated whether implementing clinical decision support (CDS) was associated with lower low-density lipoprotein cholesterol (LDL-C) in patients with severe hypercholesterolemia/possible FH (LDL-C ≥ 190 mg/dL). As part of a pre-post implementation study, a CDS alert was deployed in the electronic health record (EHR) in a large health system comprising 3 main sites, 16 hospitals and 53 clinics. Data were collected for 3 months before (‘silent mode’) and after (‘active mode’) its implementation. Clinicians were only able to view the alert in the EHR during active mode. We matched individuals 1:1 in both modes, based on age, sex, and baseline lipid lowering therapy (LLT). The primary outcome was difference in LDL-C between the two groups and the secondary outcome was initiation/intensification of LLT after alert trigger. We identified 800 matched patients in each mode (mean ± SD age 56.1 ± 11.8 y vs. 55.9 ± 11.8 y; 36.0% male in both groups; mean ± SD initial LDL-C 211.3 ± 27.4 mg/dL vs. 209.8 ± 23.9 mg/dL; 11.2% on LLT at baseline in each group). LDL-C levels were 6.6 mg/dL lower (95% CI, −10.7 to −2.5; P = 0.002) in active vs. silent mode. The odds of high-intensity statin use (OR, 1.78; 95% CI, 1.41–2.23; P < 0.001) and LLT initiation/intensification (OR, 1.30, 95% CI, 1.06–1.58, P = 0.01) were higher in active vs. silent mode. Implementation of a CDS was associated with lowering of LDL-C levels in patients with severe hypercholesterolemia/possible FH, likely due to higher rates of clinician led LLT initiation/intensification.